Epidemiology
- Prevalence: accounts for about 80% of cases of contact dermatitis
- Association with Atopy: increased
Etiology
Acids
- Hydrochloric Acid (HCl) (see Hydrochloric Acid, [[Hydrochloric Acid]])
Alkalis
- Ammonia (see Ammonia, [[Ammonia]])
- Bleach (see Chlorine, [[Chlorine]])
- Detergent
- Drain Cleaners
- Lye
- Oven Cleaners
- Soaps
- Toilet Bowel Cleaners
Bromine/Chlorine(see Chlorine, [[Chlorine]])
- xxx
Hydrocarbons (see Hydrocarbons, [[Hydrocarbons]])
- Cutting Oils
- Lubricating Oils
- Petroleum
Other Chemicals
- Creosote: acts as a contact irritant, sensitizer, and photosensitizer
- Asphalt/Tar Products
Spurge Plants
- General Comments: produce irritating white milky sap
- Candelabra Cactus
- Euphorbia Milii (Crown of Thorns, Christ Plant, Christ Thorn) (see Euphorbia Milii, [[Euphorbia Milii]])
- Euphorbia Pulcherrima (Poinsettia) (see Euphorbia Pulcherrima, [[Euphorbia Pulcherrima]])
- Euphorbia Tirucalli (Firestick, Pencil Cactus, Pencil Tree, Aveloz, Indian Tree Spurge, Naked Lady, Sticks on Fire, Milk Bush) (see Euphorbia Tirucalli, [[Euphorbia Tirucalli]])
- Poinsettia (see Poinsettia, [[Poinsettia]])
Calcium Oxalate-Containing Plants
- Dieffenbachia
- Daffodil
- Hyacinth
- Pineapple
Physiology
- Mechanism: direct injury to keratinocytes of the skin -> non-immune mechanism
- Sensitization is not required
- Involves the innate immune system
- Concentration of Agent: more critical to pathogenesis of irritant contact dermatitis than in allergic contact dermatitis
Diagnosis
- Patch Testing: negative
- Skin Biopsy: typically nonspecific
Clinical Manifestations
- Latency of Reaction After Contact: usually within 48 hrs
- Geographic Pattern
- Typically sharply demarcated and limited to the contact site
- Variable Presentation: may present as any of the following
- Mild Dryness
- Erythroderma (see Erythroderma, [[Erythroderma]])
- Maculopapular Eruption (see Exanthems, [[Exanthems]] and Papular-Nodular Skin Lesions, [[Papular-Nodular Skin Lesions]])
- Eczematous Dermatitis
- Caustic Burn with Bullae and/or Blisters (see Vesicular-Bullous Skin Lesions, [[Vesicular-Bullous Skin Lesions]])
- Other Clinical Features
- Although may be pruritic, irritant dermatitis is typically has burning or “prickling” pain
- Cumulative irritant dermatitis most commonly affects thin exposed skin regions (back of hands, between fingers, face, eyelids): long-term exposure may result in pruritus, folliculitis, calcifications, or acneiform rash
- Melanoderma: may occur with creosote or asphalt/tar products
Treatment
- Latency to Resolution: typically diminishes spontaneously within 96 hrs
References
- Contact urticaria due to the common stinging nettle (Urtica dioica)–histological, ultrastructural and pharmacological studies. Clin Exp Dermatol. 1991 Jan;16(1):1-7
- Compositae dermatitis. Australas J Dermatol. 1999 Aug;40(3):123-8 [MEDLINE]
- Long-term safety and toxicity of azathioprine in patients with air-borne contact dermatitis. Indian J Dermatol Venereol Leprol. 2001 Mar-Apr;67(2):75-7 [MEDLINE]
- Contact allergy to herbal teas derived from Asteraceae plants. Contact Dermatitis. 2006 Apr;54(4):196-201 [MEDLINE]
- Compositae dermatitis from airborne parthenolide. Br J Dermatol. 2007 Mar;156(3):510-5
- A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginous and flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions. Am J Clin Dermatol. 2011 Jun 1;12(3):171-80 [MEDLINE]